A workshop model for educating medical practitioners about optimal treatment of difficult-to-manage patients: utilization of transference-countertransference.

Some patients are unable to participate in a good, mutually cooperative relationship with their primary care doctors. They may have long-standing psychosocial difficulties exacerbated by chronic, painful, or life-threatening illnesses. Some may have somatic symptoms that they define as evidence only of an identified illness but which are reflections of psychic misery with roots in their thoughts, feelings, and relationships. This article describes a Workshop approach to teaching those patients' physicians how to make diagnostic use of their own "gut reactions" to understand the common dynamics of the doctor- patient relationship; to understand the psychological aspects of various physical symptoms; and manage challenging patients to optimize their quality of life, cost-effectiveness of treatment and minimize physician "burnout."